This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Specific Aims: The overall purpose of these investigations is to better understand factors contributing to the comparatively high incidence of prone sleep positioning in African American infants. In order to achieve this, we will address the following Specific Aims: 1) To compare knowledge, attitudes, and practices regarding infant sleep position in African American parents of higher and lower SES. 2) To identify risk factors for non-use of the recommended supine sleep position in African American families with higher SES and lower SES. 3) To develop a phenomenologic understanding of the decisions made by African American parents of higher SES and lower SES who do not use recommended supine sleep position, using qualitative techniques. Background: The incidence of sudden infant death syndrome (SIDS) in the US has declined 50% since 1992, when the American Academy of Pediatrics (AAP) first recommended that infants be placed in a nonprone position for sleep.13 Despite the tremendous success of the subsequent Back to Sleep campaign, African American infants remain twice as likely to die from SIDS.14, 15 The racial disparity exists across all educational and income categories, and the extent of the racial disparity has increased rather than decreased.14 The NICHD, in both its 2000 general Strategic Plan (From Cells to Selves) and its 2000 Strategic Plan for SIDS research (Targeting Sudden Infant Death Syndrome: A Strategic Plan), highlighted the need to understand factors leading to racial, ethnic, and social disparities as a research priority. Epidemiologic studies have demonstrated prone sleeping position to be a major risk factor for SIDS. Studies have consistently demonstrated an increased rate of prone positioning16-19 in African American infants, but very little is known about the reasons why African American parents use the prone position more often than other racial/ethnic groups. Furthermore, no studies have taken advantage of the observed socioeconomic status (SES)-associated variability in SIDS and prone sleeping within the African American community. By examining within-group differences, it is possible to move beyond comparative racial descriptions (i.e. comparisons of whites and African Americans) to identification of potentially modifiable factors that might respond to culturally acceptable interventions within a disadvantaged group. Methods: The study will be cross-sectional and will address hypothesized associations between the variables of interest that are based on a well-defined theoretical framework and previous research findings. Data will be collected using a combination of survey, semi-structured in-depth interviews, and focus groups. A total of 416 families will be recruited from primary care pediatric clinics and private practices in Washington, DC and Prince George's County Maryland. Parents will be approached in the waiting areas by trained research assistance. Parents who qualify will be asked to participate in the survey portion of the study. A validated 15 minutes survey will be conducted, with questions about knowledge, attitudes, and practice regarding sleep position. In addition, demographic information will be obtained. After completing the survey, each parent will be asked if she or he would be willing to participate in an additional interview (focus group or individual semi-structured in-depth interview) at a later date. Recruitment for participation in the qualitative interviews will be determined by responses to the survey;these qualitative interviews will be scheduled beginning after the first six months of survey collection. A total of 15 individual semi-structured in-depth interviews and 10 focus groups will be conducted. Each focus group will have six to eight participants, for a total of 60 to 80 focus group participants.